Travellers warned of fatal tick-borne disease in Western Europe

People in Spain have been warned to take precautions against a fatal disease that has now reached Western Europe. Hikers, farm workers and hospital staff could all be at risk of catching the Crimean-Congo haemorrhagic fever (CCHF), which causes diarrhoea, vomiting and heavy bleeding.

Spread by ticks, CCHF is fatal for up to 30 per cent of those who catch it. Last month, two people in Spain caught the disease – the first instance of local transmission of CCFH in Western Europe.

In its report on the two cases, the European Centre for Disease Prevention and Control (ECDC) in Solna, Sweden, concluded that the CCHF virus was most probably brought to Spain by birds migrating from Morocco or other areas of North Africa. Virus-carrying ticks may have hitched a ride on these birds, and then transferred to farm and wild animals in Spain.

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“We are targeting risk exposure groups such as livestock farmers and hunters who frequently come into contact with animals,” says Herve Zeller at the ECDC. “They can be in contact with ticks, and by crushing them it can allow the virus through their skin,” he says.

The virus first infected a 62-year-old hiker who was walking in the Avila region. This man died, after spreading the infection to a 50-year-old healthcare worker who helped treat him in Madrid. Despite severe symptoms, the healthcare worker is showing signs of recovery, according to the report.

Wide sweep

CCHF is endemic in a sweep of territories covering north-west China, India, the Middle East, Africa and the Balkans. Although mostly spread by Hyalomma ticks, the virus can also be transmitted through contact with infected blood.

The Spanish cases suggest the disease could spread in the southern countries of Western Europe. Sampling of farm and wild animals in recent years has identified ticks carrying the virus in a province of Spain called Cáceres, which borders Portugal.

“This virus has been present in these areas since 2010, but we have only one spread case in five years, so it’s a rare event,” says Zeller. Also, he says, the ticks tend to be looking to parasitise animals rather than humans.

There are no established Hyalomma tick populations in the UK, but they are present in a number of western European countries. “They’re found in southern France and Spain, but people are seldom bitten and the main hosts in these countries are tortoises, lizards, cows, donkeys, hares and foxes,” says Cheryl Whitehorn at the London School of Hygiene and Tropical Medicine.

Zeller advises travellers, hunters and hikers to avoid exposing bare skin where possible. But Whitehorn says it is extremely unlikely that a holiday-maker would acquire the disease while visiting Spain.

Article amended on
15 September 2016

Since this story was first published, the status of Hyalomma ticks in the UK has been made clearer.